scholarly journals 1067. Variation of Antimicrobial Stewardship Programs’ Membership and Organization Within a Single Health System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S378-S378
Author(s):  
J Ryan Bariola ◽  
Tina Khadem
Keyword(s):  
Information Technology ◽  
Health System ◽  
Organizational Structure ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
Joint Commission ◽  
Leadership Support ◽  
Reporting Structure ◽  
Or Organization

Abstract Background Antimicrobial stewardship programs (ASPs) vary in terms of members and administrative (admin) structure. Joint Commission (TJC) has member requirements, but little is known about adherence or how ASP’s fit into hospitals’ admin structures. We reviewed the makeup and organization of ASP’s within a single healthcare system. Methods Survey of pharmacy directors or ASP pharmacists at 14 system hospitals in January 2019. Results All hospitals responded. All are TJC accredited. Thirteen (92%) had a local stewardship committee. Of these 13, 6 (42%) met quarterly, 4 (30%) monthly, and 3 (21%) every other month. 9 (69%) were a subcommittee of Pharmacy and Therapeutics, and 1 (11%) was a separate committee. 3 (23%) had no clearly defined reporting structure. Figure 1 shows ASP committee compositions. 9 (69%) had all TJC required members, if ID physician is considered a required member. All had pharmacy representation but only 4 (30%) had a pharmacist with ID training. Most had representation from ID physicians (10), Infection Prevention (12), other practitioners (11), and microbiology lab (9). Less than half had hospital admin members, and only 2 had nursing members. None had Information Technology (IT) representation. 12 (92%) created minutes, but only 4 (30%) forwarded minutes for review by hospital admin. Tables 1–3 describe relationships between hospitals based on bed size, if they submitted minutes for review, and if they had both an ID pharmacist and ID physician as members. No hospital indicated citations during a TJC visit about membership or organization. Conclusion ASPs within even a single health system vary as to membership and organizational structure. Some did not have all TJC required members. With few having admin representation or submitting minutes for admin review, it raises the concern of ASPs being ignored and possible noncompliance with TJC requirements regarding leadership support. ASP’s should actively work with hospital admins to ensure they have all needed representation and develop reporting mechanisms that keep hospital admins aware of their successes and needs. Lack of involvement from pharmacists with ID expertise, nursing, and IT are issues also. Larger evaluations are needed to determine whether membership and administrative structure can impact antimicrobial usage. Disclosures All authors: No reported disclosures.

scholarly journals A survey of the knowledge and attitudes of Egyptian healthcare professionals towards the application of Health Information Technology to optimize antibiotic therapy

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i28-i28
Author(s):  
N Hassan ◽  
R Slight ◽  
S P Slight
Keyword(s):  
Information Technology ◽  
Developing Countries ◽  
Antimicrobial Resistance ◽  
Health Information Technology ◽  
Health Information ◽  
Antimicrobial Stewardship ◽  
Healthcare Professionals ◽  
Response Rate ◽  
Public Healthcare ◽  
P Value

Abstract Introduction Antimicrobial resistance is a global health problem, especially in developing countries. Antimicrobial Stewardship Programmes (AMS) have been shown to be effective at reducing antimicrobial resistance and hospital patient stays. Health information technology (HIT) can support Outpatient Parenteral Antimicrobial Therapy (OPAT) through more accurate diagnosis and management of infectious diseases. Aim To evaluate the knowledge and attitude of Egyptian healthcare professionals towards the application of HIT to optimize OPAT. Methods Healthcare professionals who worked in either private or public sectors of Egyptian healthcare system were emailed and asked if they would be willing to complete an electronic questionnaire (using google forms). One reminder was sent by email each week for two weeks (two in total) from the first invitation. The survey was laid out in four sections. The first section included specific details about the healthcare professional’s current employment and role, the second related to HIT services available in their organisations, the third covered their training in HIT and antimicrobial stewardship programmes, and the fourth included their use of HIT to optimize OPAT. Ethical approval was obtained from National Heart Institute, Egypt. Descriptive analysis was carried out for all the variables. One-way ANOVA testing at level of significance P-value <0.05, was used to compare numerical variables. SPSS version 26 was used for statistical analysis. Results Three hundred and eighty-five healthcare professionals were invited to respond to the questionnaire. (The response rate was 75.34% (290)). Of these, 152 (52.6%) were pharmacists, 134 (46.4%) physicians, and 3 (1%) nurses, and many participants (30.8%) had between 6 to 10 years of experience working in either outpatient or in-patient units. Only 15.2% of respondents mentioned that they have access to OPAT in their organizations, 51.2% did not have the service, while 33.6% responded that they did not know if the service was available. However, 27.3% had a training on ASP and 18.3% had a training on HIT. Mean scores for both knowledge (14.31±5.49) and attitude (14.67±2.53) were significantly higher in professionals who had received training in HIT (p = 0.003 & 0.006 respectively). However, scores for attitude were better than scores for knowledge. Conclusions In developing countries, HIT applications in OPAT are still in their infancy with only a few organisations adopting them. Egyptian healthcare professionals showed positive attitudes towards HIT use, especially when their knowledge was improved through training. Two strengths of this study include our high response rate and the wide breadth of different healthcare professionals who responded from both private and public healthcare settings. However, being a questionnaire, some questions were left unanswered and some respondents may not have been aware of their reasons for a particular answer. That said, this study has important implications for practice, with more awareness amongst healthcare professionals required on the availability of HIT services in their hospitals and how further training may be needed on the applications of HIT in optimizing OPAT.

scholarly journals Where to from here? Identifying and prioritising future directions for addressing drug-resistant infection in Australia

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gregory Merlo ◽  
Minyon Avent ◽  
Trent Yarwood ◽  
Bonnie Smith ◽  
Mieke van Driel ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
Implementation Strategies ◽  
Antibiotic Use ◽  
Future Directions ◽  
World Cafe ◽  
Resistant Infection ◽  
Using Data ◽  
Patient Stories

Abstract Background The Australian National Antimicrobial Resistance Strategy calls for a collaborative effort to change practices that have contributed to the development of drug-resistance and for implementation of new initiatives to reduce antibiotic use. Methods A facilitated workshop was undertaken at the 2019 National Australian Antimicrobial Resistance Forum to explore the complexity of antimicrobial stewardship (AMS) implementation in Australia and prioritise future action. Participants engaged in rotating rounds of discussion using a world café format addressing six topics relating to AMS implementation. Once all tables had discussed all themes the discussion concluded and notes were summarised. The documents were independently openly coded by two researchers to identify elements relating to the implementation of antimicrobial stewardship. Results There were 39 participants in the facilitated discussions, including pharmacists, infectious disease physicians, infection prevention nurses, and others. Participants discussed strategies they had found successful, including having a regular presence in clinical areas, adapting messaging and implementation strategies for different disciplines, maintaining positivity, and being patient-focused. Many of the recommendations for the next step involved being patient focussed and outcomesdriven. This involves linking data to practice, using patient stories, using data to celebrate wins and creating incentives. Discussion Recommendations from the workshop should be included in priority setting for the implementation of AMS initiatives across Australia.

scholarly journals Survey of Infection Prevention Informatics Use and Practitioner Satisfaction in US Hospitals

2014 ◽  
Vol 35 (7) ◽  
pp. 891-893 ◽  
Author(s):  
Max Masnick ◽  
Daniel J. Morgan ◽  
Marc-Oliver Wright ◽  
Michael Y. Lin ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
Infect Control Hosp ◽  
Infection Preventionists

We surveyed hospital epidemiologists and infection preventionists on their usage of and satisfaction with infection prevention–specific software supplementing their institution’s electronic medical record. Respondents with supplemental software were more satisfied with their software’s infection prevention and antimicrobial stewardship capabilities than those without. Infection preventionists were more satisfied than hospital epidemiologists.Infect Control Hosp Epidemiol 2014;35(7):891–893

scholarly journals A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sanjeev Singh ◽  
Esmita Charani ◽  
Sarada Devi ◽  
Anuj Sharma ◽  
Fabia Edathadathil ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
The State ◽  
Action Plans ◽  
Public And Private ◽  
Middle Income ◽  
Middle Income Countries ◽  
Public Health Threat

Abstract Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

scholarly journals Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System

2020 ◽  
Vol 41 (S1) ◽  
pp. s321-s321
Author(s):  
Stephanie Shealy ◽  
Joseph Kohn ◽  
Emily Yongue ◽  
Casey Troficanto ◽  
Brandon Bookstaver ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Healthcare Providers ◽  
The United States ◽  
Antimicrobial Use ◽  
Gram Positive ◽  
Specific Patient ◽  
Antimicrobial Administration

Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None

scholarly journals 1655. Extrapulmonary Tuberculosis in a Large Healthcare System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S816-S816
Author(s):  
Travis Denmeade ◽  
William Smith ◽  
Banks Kooken ◽  
Michael Leonard
Keyword(s):  
Health System ◽  
Healthcare System ◽  
Extrapulmonary Tuberculosis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Hiv Positive ◽  
Hiv Status ◽  
Southeastern Us ◽  
Race Ethnicity

Abstract Background The US has seen a rise in the proportion of patients with extrapulmonary tuberculosis (TB) even though the yearly incidence of new TB cases has been in decline. The purpose of this study was to analyze incidence of extrapulmonary TB at Atrium Health, a large non-profit health system in the Southeastern US. Methods Retrospective chart review of 94 adult patients with culture confirmed extrapulmonary TB between 2008-2019. Individuals younger than 18 years were excluded from analysis. The primary objective was to examine incidence of extrapulmonary TB and compare it to that reported in the literature. Secondary objectives included determination of sites of extrapulmonary disease and associated patient characteristics including HIV status, race, ethnicity, and birthplace. Results 237 patients were identified as having confirmed TB infection from 2008-2019 in a retrospective analysis within the Atrium Health System. 94 (40%) were found to have extrapulmonary disease; 42 (45%) with concomitant pulmonary disease. The patients were 55% male, 40% African American, 21% Hispanic or Latino, and 51% US-born. Median age was 44 years (range 20-62). The most common sites of extrapulmonary TB were lymphatic (35%), pleural (24%), GI/Peritoneal (12%), CNS (10%), and Bone/Joint (10%). Lymphatic involvement was 40% cervical, 19% intrathoracic, and 16% axillary. 66% of skeletal disease was vertebral. Other sites included GU, pericardial, skin, and disseminated disease (5%). 37% were HIV positive, 18% with unknown HIV status as they were never tested. Information regarding patient’s race, ethnicity, and birthplace were unknown for 2 patients. The percentage of extrapulmonary cases were 29% in 2008, 39% in 2012, 38% in 2016, and 49% in 2019. Conclusion Lymphatic and pleural involvement were the most common extrapulmonary sites. Of those tested, 37% were HIV positive but there was a significant portion never tested showing a need for increased testing. The proportion of extrapulmonary TB cases since 2008 is higher at 40% compared to the 31% reported in the United States. There has been a rise in the proportion of extrapulmonary TB within our healthcare system and deserves further analysis. Disclosures All Authors: No reported disclosures

A view from abroad: a New Zealand perspective on the English NHS health reforms

2016 ◽  
Author(s):  
Robin Gauld
Keyword(s):  
Health Policy ◽  
New Zealand ◽  
Health System ◽  
Access To Care ◽  
Healthcare System ◽  
National Health ◽  
Universal Access ◽  
National Health System ◽  
High Income ◽  
Coalition Government

The English NHS is of significance among health policy observers around the globe for various reasons. The NHS is particularly noteworthy for the fact that, for many, it represents the high-income world’s best attempt to have built and maintained a ‘national’ health system with a focus on universal access to care that is free at point of service. The NHS has been in transition for several years. Many commentators have highlighted the role and influence of US market ideals in this transition, with various UK governments clearly pushing this agenda. However, is often useful to look to countries more closely comparable to England, such as New Zealand, for comparison with a view to improvement. This chapter takes such an approach in looking at the NHS from abroad. It draws upon the case of NZ which, in many ways, is very similar to England when it comes to health policy and the healthcare system. In doing so, it aims to provide a critique of the NHS reforms and demonstrate that there are alternatives to the policies and structures being pursued for the English NHS by the Coalition government.

scholarly journals Antimicrobial Stewardship Standards and Patient Safety: A Case Study in Blood Culture Contamination

2021 ◽  
Vol 1 (S1) ◽  
pp. s36-s36
Author(s):  
Connie Schaefer
Keyword(s):  
Blood Culture ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Standard Method ◽  
Broad Spectrum ◽  
Emergency Departments ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Broad Spectrum Antibiotics ◽  
Contamination Events

Background: Blood culture is a crucial diagnostic tool for healthcare systems, but false-positive results drain clinical resources, imperil patients with an increased length of stay (and associated hospital-acquired infection risk), and undermine global health initiatives when broad-spectrum antibiotics are administered unnecessarily. Considering emerging technologies that mitigate human error factors, we questioned historically acceptable rates of blood culture contamination, which prompted a need to promote and trial these technologies further. In a 3-month trial, 3 emergency departments in a midwestern healthcare system utilized an initial specimen diversion device (ISDD) to draw blood cultures to bring their blood culture contamination rate (4.4% prior to intervention) below the 3% benchmark recommended by the Clinical & Laboratory Standards Institute. Methods: All emergency department nursing staff received operational training on the ISDD for blood culture sample acquisition. From June through August 2019, 1,847 blood cultures were drawn via the ISDD, and 862 were drawn via the standard method. Results: In total, 16 contamination events occurred when utilizing the ISDD (0.9%) and 37 contamination events occurred when utilizing the standard method (4.3%). ISDD utilization resulted in an 80% reduction in blood culture contamination from the rate of 4.4% rate held prior to intervention. Conclusions: A midwestern healthcare system experienced a dramatic reduction in blood culture contamination across 3 emergency departments while pilot testing an ISDD, conserving laboratory and therapeutic resources while minimizing patient exposure to unnecessary risks and procedures. If the results obtained here were sustained and the ISDD utilized for all blood culture draws, nearly 400 contamination events could be avoided annually in this system. Reducing unnecessary antibiotic use in this manner will lower rates of associated adverse events such as acute kidney injury and allergic reaction, which are possible topics for further investigation. The COVID-19 pandemic has recently highlighted both the importance of keeping hospital beds available and the rampant carelessness with which broad-spectrum antibiotics are administered (escalating the threat posed by multidrug-resistant organisms). As more ambitious healthcare benchmarks become attainable, promoting and adhering to higher standards for patient care will be critical to furthering an antimicrobial stewardship agenda and to reducing treatment inequity in the field.Funding: NoDisclosures: None

scholarly journals Strengthening the Somaliland health system by integrating public and private sector family medicine

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Muna M. Mahfud ◽  
Fathia M. Nour ◽  
Hodan J. Abdi ◽  
Sabah M. Muse ◽  
Tim Fader
Keyword(s):  
Family Medicine ◽  
Private Sector ◽  
Health System ◽  
Healthcare System ◽  
Clinical Care ◽  
Family Physicians ◽  
Public Private Partnerships ◽  
Specialty Training ◽  
Public And Private ◽  
Public And Private Sector

Four family physicians, who received their specialty training at Amoud University in Somaliland, organised a practice together that uses informal public–private partnerships to optimise their clinical care and teaching. Their experience offers insights into public–private partnerships that could strengthen the country’s healthcare system.

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